Provider Demographics
NPI:1538333695
Name:HEDMAN, JACQUELYN RENEE (NP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:RENEE
Last Name:HEDMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 DUNCAN RD.
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-8101
Mailing Address - Country:US
Mailing Address - Phone:706-533-1956
Mailing Address - Fax:
Practice Address - Street 1:1000 CLYBURN PL
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4193
Practice Address - Country:US
Practice Address - Phone:803-380-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN182772163WX0200X
GA182772363LP0808X
FL11000933363LP0808X
SC22343A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WX0200XNursing Service ProvidersRegistered NurseOncology